Bacterial tracheitis

Abstract

During a 14 mo. period, 8 infants and children were observed with an acute, infectious upper airway obstructive disease with features common to croup and epiglottitis. This distinct entity was termed bacterial tracheitis. All patients failed to respond to treatment for croup, including racemic epinephrine delivered by intermittent positive-pressure breathing. Direct laryngoscopy consistently revealed a normal epiglottis and aryepiglottic folds but marked subglottic mucosal edema. Tracheal suctioning yielded copius mucopus below the subglottic swelling. Gram stain of this material corroborated subsequent cultures: Staphylococcus aureus, 6; group A Streptococcus, 1; and Haemophilus influenzae (not typed), 1. All patients required periodic tracheal suctioning for relief of upper airway obstruction. Six patients required endotracheal intubation; 1 required a tracheostomy. Bacterial tracheitis should be considered in the differential diagnosis of a young child with a croup-like illness that is refractory to conventional therapy.